* Please complete all mandatory fields featuring an asteriskFirst, a bit about you.
Personal Details
Title (Mr, Mrs, Miss etc.)

Address

First Name(s)Surname/Family Name

Post CodeTel No. (incl. std code)

Email address

Mobile No.

National Insurance Number

Are you over 18? YN

If no, provide date of birth D

Do you hold a valid driving licence?

YNDMMYY

Do you have any endorsements Y

Have you completed this form yourself? YN

If so, state endorsements and dates

Emergency Contact Details
Contact Name

Address

Relationship to youTel No. (incl. std code)
Post CodeMobile No.

Tell us your achievements at school or college.
Education & Training
Please provide all qualifications from school through to college and university or any other relevant training courses.

... And what you achieved after.
Additional Qualifications/Memberships/Licences
Please detail any qualifications or memberships to professional organisations/bodies relevant to the position you have applied for.
Qualification/Membership/Reg. No.

Organisation

Date AwardedN*

So where are you working now?
Current/Most Recent Employment Details
Full name and address of employer

Outline the nature of your job and your responsibilities

Contact number
Job Title

Date fromto

Annual Salary/Hourly Rate

Additional benefits:

Notice period required

Why are you considering leaving/have left?

What about before then?
Previous Employment including Work Placements
Full name and address of employer

Outline the nature of your job and your responsibilities

Contact number
Job Title

Date fromto

Annual Salary/Hourly Rate

Reason for leaving:

Full name and address of employer

Outline the nature of your job and your responsibilities

Contact number
Job Title

Date from

Annual Salary/Hourly Rate

Reason for leaving:

People who can tell us how good you are.

to*

Personal References
You must provide two personal referees. These should not be relatives but could be a school/college tutor or other professional
person excluding your GP.
Name

Name

Address

Address

Post Code

Post CodeTelephone NoTelephone NoProfession

Profession

How long have you known this person?

How long have you known this person?

In what capacity have you known this person?

In what capacity have you known this person?

Please note that employment references will be sought from your last employer and after acceptance of employment, also fromyour current employer. The company retains the right to withdraw the offer of employment or terminate the contract of employment should
unacceptable references be received. Completion of this application form will be taken as your consent to apply for references.

Information for us to keep...
Health questionnaire incorporating
working time directive 1998
YN

Chest problems eg, persistent cough, asthma, bronchitis,
pneumonia etcYN

Heart/Circulation problems eg. Angina, palpitationis, high bloodpressure, varicons veins, vibration white finger etc

YN

Recurrent stomach problems

YNDiabetes

YNBack, neck or joint problems

YN

Eplipesy or blackouts

YN

Eye disease or poor vision

YN

Ear disease or difficulty hearing

YN

Skin disease eg. Eczema, dermatitis etc

Y

N

Recurring headache / migraine

YN

Any allergy including hayfever

Y

N

Have you had any psychiatric illness including anxiety,depression, stress etc

NIf ‘Yes’, do we need to make specific arrangements in order for you toattend to attend an interview?
Please tick YNIf ‘Yes’, detail arrangements that would assist you.

Brunswick Moviebowl is an equal opportunities employer. We do notdiscriminate on the grounds of political opinion or religious belief. We
practice equality of opportunity in employment and select the best person
for the job. To demonstrate our commitment to equality of opportunity inemployment we need to monitor the community background of ourapplicants and employees, as required by the Fair Employment andTreatment (NI) Order 1998.
We are therefore asking you to complete the Monitoring Form attached tothis application. Please tick the appropriate box to indicate yourcommunity background. This will be detached and filed separately onreceipt of this application form.

Criminal Records*

Data Protection

Have you ever been convicted of a criminal offence, been ‘bound over’or subjected to a caution?
NPlease tick Y

If ‘Yes’ please give details of the type of offence, fine, sentence etc, andput in separate envelope. This will only be opened if you are considered
for appointment and will be returned to you.

Child and Vulnerable Adults Protection*

Have you ever been the subject of or are you currently aware of
any allegations made against you in relation to Child andVulnerable Adults protection?
NBrunswick Moviebowl undertake that it will treat any personal
information (that is data from which you can be identified, suchas your name, address, email etc.) that you provide to us, or we
obtain from you, in accordance with the Data Protection Act
1998. If you are returning this form by email, you will be asked
to sign it at interview.

Immigration, Asylum andNationality Act 2006

*Under the Immigration, Asylum and Nationality Act 2006, you are required
to provide evidence of your right to work in the UK, if called for an interview
you will be advised of the documents you will need to provide which willthen be checked to ensure the company complies with current legislation
If you have a National Insurance number please write it here.

Country of birth

Please tick Y

Equal Opportunity Monitoring

Details

Town of birth*We welcome applications from people with disabilities. The Disability
Discrimination (NI) Act 1995 describes a disability as “a physical or mental
impairment that has a substantial and adverse long-term effect on aperson’s ability to carry out normal day to day activities.
Having read and understood the above definition, do you have a disability?

Do you or have you ever suffered from any of the following:

Please tick Y

Disability Discrimination (NI) Order 2006

Upon receipt of your application form, Brunswick Moviebowl will be the Data
Controller of your personal data. Brunswick Moviebowl will hold all theinformation you have given on this application form for legal requirements
and for the purposes of personnel administration and statistical analysis.
Your information will be held on a manual file and will also be entered in its
current or altered format onto the company’s computerised database.
No information may be passed onto a third party unless contracted
to Brunswick Moviebowl for specific employment services without yourexpress agreement unless required by law.
Your signature below indicates your agreement to the above.

Declaration*I declare that I have read and understand all questions and parts of thisapplication form and that all the information given by me on this form istrue and correct to the best of my knowledge and belief.
SignedDateDDMMYYReturn Completed Application Forms to:Brunswick Moviebowl, Brunswick Lane,Pennyburn, BT48 OLU

Monitoring FormFair Employment and Treatment (NI) Order 1998
This form asks you to provide information from which your preferred affiliation can be determined. The
following explains why this is done:
We are fair employers. We do not discriminate on the grounds of religious belief, political opinion, gender,race, disability or age. We practice quality of opportunity in employment. We select the best person for thejob, promotion or opportunity in employment. To do this we need to monitor the perceived religious affiliation of
our employees and job applicants in accordance with the above Government Act.
Therefore we are asking you to help us by indicating the community to which you belong. The information you
are providing will be treated in strict confidence and protected from misuse. It will be used only by us tomonitor our equality of opportunity in employment policies.

Please indicate the community to which you belong by ticking the appropriate box:
I am a member of the Roman Catholic community
I am a member of the Protestant community
I am neither a member of the Protestant or Roman Communities
MaleWhen you have completed this form, return it with your application.
This form will be detached on receipt.

Thank you for your co-operation.

Female